The efficacy of an intervention for PTSD among illicit drug users

在澳大利亚和国际文献中都清楚地认识到，在非法药物使用障碍（IDUD）人群中，PTSD的患病率很高。在澳大利亚，33%的阿片类药物使用障碍患者和24%的安非他明使用障碍患者患有PTSD合并症。另一方面，酒精使用障碍患者的患病率相对较低（5%）。尽管IDUD患者中PTSD的患病率很高，但对这一重大问题的治疗反应的研究却很少。患有这种合并症的个体对药物滥用治疗提供者提出了重大挑战，因为他们的临床表现较差，治疗结果较差，包括再入院率较高。因此，它们对卫生保健系统来说是一个昂贵的负担。通过实施同时解决这两种疾病的综合治疗，可能会大大降低患者个人和社会的合并症成本。然而，很少有研究指导如何最好地治疗宫内节育症和创伤后应激障碍。虽然已经开发和试验了少数干预措施，但没有一个在澳大利亚环境中进行过评估。一种在美国已经显示出希望的干预措施是PTSD和物质使用障碍的同时治疗（CTPSD）。初步研究表明，CTPSD可以安全有效地用于治疗可卡因依赖者的PTSD。该项目的完成者已经证明，从基线到治疗结束，所有创伤后应激障碍症状群和可卡因的使用都有显著的减少，并保持了6个月的随访。抑郁症状也显著减轻。尽管有这些令人鼓舞的结果，但CTPSD尚未进行随机对照试验。拟议的研究是一项随机对照试验，在澳大利亚设置CTPSD的疗效。

The high prevalence of PTSD among people with illicit drug use disorders (IDUD) has been clearly recognised in both the Australian and international literature. In Australia, 33% of those with opioid use disorders and 24% of those with amphetamine use disorders have comorbid PTSD. The prevalence among people with alcohol use disorders on the other hand, is comparably low (5%). Despite the high prevalence of PTSD among people with IDUD, research on treatment responses to this significant problem is sparse. Individuals with this comorbidity present a significant challenge to substance abuse treatment providers as they present with a poorer clinical profile, and have poorer treatment outcomes, including higher readmission rates. Consequently, they are a costly burden to the health care system. The costs of this comorbidity to individual sufferers and society may be reduced substantially by the implementation of an integrated treatment that addresses both disorders concurrently. There is however, little research to guide how best to treat comorbid IDUD and PTSD. Although a small number of interventions have been developed and trialled, none have been evaluated in an Australian setting. One intervention which has shown promise in the United States is Concurrent Treatment of PTSD and Substance Use Disorder (CTPSD). Preliminary research has shown that CTPSD can be used safely and is effective in the treatment of PTSD among individuals with cocaine dependence. Completers of the program have demonstrated significant reductions in all PTSD symptom clusters and cocaine use from baseline to end of treatment which were maintained at 6 month follow-up. Significant reductions in depressive symptoms were also observed. Despite these promising results, CTPSD is yet to undergo a randomised controlled trial. The proposed study is a randomised controlled trial of the efficacy of CTPSD in the Australian setting.